09/04/2026
Common Scrotal Conditions:
Acute Scrotal Conditions (Sudden, Often Painful)
1. Testicular Torsion:
Cause: Spermatic cord twists, cutting off blood supply (bell clapper deformity).
Signs: Sudden severe pain, high/horizontal testicle, absent cremasteric reflex. Surgical emergency.
2. Epididymitis:
Cause: Infection (STIs 35/hetero), urine reflux.
Signs: Gradual pain/swelling, tender epididymis, present cremasteric reflex, possible fever/dysuria.
3. Orchitis:
Cause: Viral (Mumps) or bacterial (secondary to epididymitis).
Signs: Testicular inflammation, pain/swelling, systemic symptoms (fever, malaise).
4. Appendix Te**is Torsion:
Cause: Twisting of small vestigial appendage.
Signs: Less severe pain, upper pole localization, sometimes “blue dot sign,” intact cremasteric reflex.
5. Testicular Rupture:
Cause: Severe blunt trauma.
Signs: Extreme pain, massive swelling/ecchymosis, disrupted testicle on ultrasound. Surgical emergency.
6. Acute Hydrocele/Hematocele:
Cause: Rapid fluid (hydrocele) or blood (hematocele) accumulation (trauma, inflammation).
Signs: Rapid scrotal swelling, discomfort.
Chronic Scrotal Conditions (Gradual, Often Painless/Mild)
1. Varicocele:
Cause: Dilated pampiniform plexus veins (usually left-sided).
Signs: “Bag of worms” feeling, worse standing, may affect fertility.
2. Spermatocele (Epididymal Cyst):
Cause: Benign sperm-containing cyst in epididymis.
Signs: Painless, smooth lump (superior/posterior to testicle), transilluminates.
3. Hydrocele (Chronic):
Cause: Fluid in tunica vaginalis (idiopathic, inflammation).
Signs: Painless fluid-filled swelling, transilluminates.
4. Testicular Mass (Tumor):
Cause: Testicular cancer (seminoma, non-seminoma).
Signs: Painless, firm lump, no transillumination. Urgent urology referral.
5. Chronic Epididymitis/Orchitis:
Cause: Unresolved acute infection or inflammation.
Signs: Persistent discomfort